As an alternative, a less invasive, deltoidsplit ds approach fig. Unusual anatomic variant of the axillary nerve challenging. Annotations api oai service bulk downloads developers forum. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary ne. Treatment and outcome of malignant bone tumors of the. For complex and unstable fractures locking proximal humerus plate. Can be extended distally to incorporate the anterior approach to the humerus. The deltopectoral approach for reverse shoulder arthroplasty made through the subscapularis tendon if present and capsule 1 cm medial to its insertion on the proximal humerus if the subscapularis tissue quality is adequate for mobilization for repair and if passive external rotation preoperatively is equal to or greater than 20 figure 5. Deltoidsplit approach versus deltopectoral approach for proximal humerus fractures. Minimally invasive application of the noncontactbridging ncb plate to the. Once this was done, the stem was prepared up to a size 10. Read deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures.
For displaced multifragmentary fractures, a deltopectoral approach is used which allows good reduction and visualization. Author links open overlay panel linzhen xie a 1 yingying zhang b 1 chunhui chen a wenhao zheng a hua chen a 2 leyi cai a 2. The deltoid splitting approach is reserved for 2part fractures only. Various articles have reported successful outcomes using the phlp when compared with other implant designs. The deltopectoral approach is a welldescribed and commonly utilized surgical approach to the glenohumeral joint and proximal humerus for both shoulder arthroplasty and fracture fixation 1,2,3. Research article open access minimally invasive plate. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to 1. This article is from the open orthopaedics journal, volume 5. The pectoralis fascia is incised lateral to the tendon of the short. Dec 11, 20 proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. Surgical approach of open reduction and internal fixation for. The cephalic vein is identified proximally and usually retracted laterally while exposing the deltopectoral plane.
For complex and unstable fractures locking proximal. To avoid damaging the axillary nerve, do not split. This study retrospectively evaluated functional outcomes of locked plate fixation vs hemiarthroplasty in 57 patients with 3 and 4part proximal humerus fractures from 2003 to 2005 with a mean. However, it provides only limited exposure of the lateral and. Many patients choose open reduction and internal fixation. A minimally invasive approach for plate fixation of the.
The treatment of these fractures remains controversial. Standard deltopectoral approach exposed the fracture. Dec 11, 20 read deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Our study is to evaluate the clinical outcomes and effectiveness of a modified anterolateral approach and intraosseous portal in minimally invasive treatment for threepart proximal humeral fractures in comparison to the traditional deltopectoral approach. Schematic diagram for deltopectoral approach ds and deltoidsplit approaches dp.
Request pdf deltopectoral approach as the most commonly used approach in the shoulder, deltopectoral approach is used for reduction and internal fixation of proximal humerus. Advantage of minimally invasive lateral approach relative to. Extended anterolateral approach cambridge orthopaedics. The anatomical relationship to the axillary nerve in mi surgical treatment of proximal humerus fractures using the minimal anterolateral acromial approach is close, and there is the risk of nerve lesion 15 roderer g, abouelsoud m, gebhard f, bockers tm, kinzl l. If the anterior fragment consists of the lesser tuberosity, the. The extended deltopectoral approach remains the most widely used for this purpose. There are two options when choosing the surgical approach for locking plate fixation to treat proximal humerus fractures phf.
Humerus anterior approach brachial split incision academy. Conventional surgical methods of orif use the deltopectoral approach dp as fig. Deltoidsplit or deltopectoral approaches for the treatment of. Functional outcomes for surgically treated 3 and 4part. Deltopectoral vs deltoid split approach for proximal humerus. The prospective evidence suggested that ds approach for proximal humerus fractures had less humeral head necrosis.
Approach a deltopectoral or transdeltoid approach is recommended. Jan 12, 2014 surgical approaches to distal humerus fractures dr. Superficial dissection substep structure actions specification 1a skin mark mark the skin over the coracoid process at 23 of the length of the clavicle, and the lateral tip of the acromion. Open subtypes 3 open subtypes 3 your digital gateway to expertise, education, and innovation. The length of the incision is determined by the plate used. A 66yearold sustained a left proximal humerus fracture. The deltopectoral approach requires extensive soft tissue dissection and muscle retraction to gain. Electrophysiological assessment of the deltoid muscle after minimally invasive treatment of proximal humerus fractures a clinical observation. The deltopectoral approach to the shoulder requires extensive soft tissue dissection and muscle retraction to gain adequate exposure of the lateral aspect of the humerus. Proximal humerus approach deltopectoral approach to the proximal humerus ao surgery reference free download as pdf file. Background the deltopectoral approach is a welldescribed surgical approach to the proximal humerus and glenohumeral joint. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis mipo for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. To investigate the evidence of deltoidsplit approach ds versus deltopectoral approach dp in treatment of proximal humerus fractures from current rct and prospective literatures.
It was only necessary to develop the proximal portion because dissection to the forearm was unnecessary for the approach. Various soft tissue releases can be performed to obtain adequate glenoid exposure, but their effectiveness is not known. This prospective randomized study was performed to evaluate the clinical outcomes after osteosynthesis of proximal humeral fractures with a polyaxial locking plate using either the less invasive, deltoidsplit approach or the deltopectoral approach, specifically evaluating for differences in complication rate, function, and pain. We report the use of an orthogonal tubular plate to augment the proximal humerus locking plate. Surgical approach of open reduction and internal fixation. The greater tuberosity was repaired with additional sutures.
The deltopectoral approach for exposure of the anterior and lateral shoulder region has been most commonly used for plating of the proximal humerus. Deltopectoral vs deltoid split approach for proximal. Surgical technique for open reductioninternal fixation of an. Extensive dissection anteriorly may further compromise humeral head blood supply see, anterior circumflex humeral artery, humeral head blood supply. Modified minimally invasive approach and intraosseous. The proximal humeral locking plate phlp is a recently developed fixedangle implant that is an option for open reductioninternal fixation of an unstable displaced proximal humeral fracture. The deltopectoral approach is commonly used in shoulder arthroplasty. Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. Difference between radiological and functional outcome with deltoidsplitting approach versus deltopectoral approach for the management of proximal humeral fractures with philos plate shah waliullah, ashish kumar department of orthopaedic, king. The radial nerve is at risk of injury during surgical approaches to the humeral shaft. Open reduction internal fixation of displaced 3 and 4part proximal humerus fractures is an effective treatment modality particularly for the younger age group, but it is not without complications. Modified minimally invasive approach and intraosseous portal. Surgical exposures of the humerus location procedure clinical example surgical approach concerns and limitations proximal total shoulder arthroplasty conventional or reverse prosthesis deltopectoral axillary nerve, anterior humeral circum. Between 1998 and 2010, 41 consecutive proximal humeral reconstructions using prosthesis group p, n 25 or recycled pasteurized autograft combined with nonvascularised fibula autograft.
Deltopectoral approach to the proximal humerus and many more surgical approaches described step by step with text and illustrations. Using a modification of this approach, we describe its use in a group of patients requiring either internal fixation or hemiarthroplasty for proximal humeral fracture and the effect of this approach on the postoperative function on the axillary nerve and deltoid muscle. Pdf background debate exists over the optimal approach for addressing fractures of. Use of locked plating in proximal humerus fractures. However, some authors have argued that this approach involves extensive soft tissue dissection and muscle retraction to gain adequate exposure to the lateral aspect of the humerus. The purpose of this study was to compare the outcome, complications and survival of the commonly used surgical reconstructions of the proximal humerus after intrarticular tumour resection in our hospital. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a. The deltoid split ds approach, developed according to minimally invasive surgery principles, and the classic deltopectoral dp approach, believed to increase the risk of avascular necrosis and making access to the. For displaced fractures that meet surgical indications, the traditional deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. Learn about the humerus deltopectoral approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. As the most commonly used approach in the shoulder, deltopectoral approach is used for reduction and internal fixation of proximal humerus fractures, to treat bony glenoid injuries, shoulder. Electrophysiological assessment of the deltoid muscle after. Surgical approaches to distal humerus fractures dr. The incidence of proximal humeral fracture is increasing gradually.
Different approaches have been utilized in the surgical intervention of threepart fractures. An anatomic study of the cephalic vein in the deltopectoral shoulder approach. The axillary nerve can be palpated at the lower margin of the incision. A quantitative comparison of the deltopectoral approach and the. Our study is to evaluate the clinical outcomes and effectiveness of a modified anterolateral approach and intraosseous portal in minimally invasive treatment for threepart proximal humeral fractures in comparison to the traditional deltopectoral. Despite the fact that the axillary nerve does not function normally following a lessinvasive approach for fixation of proximal humerus fractures, this does not appear to affect the.
Advantage of minimally invasive lateral approach relative. Overview this approach can be a fairly extensile exposure, allowing access to the anterior, medial, and lateral aspects of the shoulder. Feb 15, 2015 however, this approach provides limited exposure of the posterior aspect of the proximal humerus due to the pull of the cuff muscles and the lateral aspect where the plate is placed. The deltopectoral approach is a welldescribed surgical approach to the proximal humerus and glenohumeral joint. The deltopectoral approach is a welldescribed and commonly utilized surgical approach to the glenohumeral joint and proximal humerus for both shoulder arthroplasty and fracture fixation 12 3. Deltoidsplit approach versus deltopectoral approach for proximal. Minimally invasive plate osteosynthesis for proximal. The approach can be extended into an anterolateral approach to the humerus. Supine extensile approach to the anterolateral humerus. The deltopectoral approach for reverse shoulder arthroplasty.
Electrophysiological assessment of the deltoid muscle. The fracture site was identified and fragments were mobilized and the humeral head fragments removed. Surgical indications include displaced, comminuted unstable fractures and fracture dislocations. An anterosuperior approach for proximal humeral fractures. The use of minimally invasive plate osteosynthesis mipo via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. The purpose of this study was to 1 quantify the effects of various releases on the amount of glenoid surface area exposure and 2 determine if common soft tissue releases performed about the shoulder. The purpose of this study was to objectively quantify the surface area of the humerus exposed using the deltopectoral dp and anterolateral acromial ala approaches and to compare visualized and palpable anatomic landmarks. Methods the electronic literature database of pubmed, embase, and cochrane library was searched at december 2017. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. However, some authors have argued that this approach involves extensive soft tissue dissection and muscle retraction to gain adequate exposure to the lateral aspect of the.
However, many complications still occur with use of the phlp, such as avascular necrosis of. The surgery was performed via a deltopectoral approach fig. Standard deltopectoral approach was used and dissection was carried down to the fracture site. The extended deltoidsplitting approach to the proximal humerus. Extend the skin incision down the deltopectoral groove. The deltoid splitting approach is reserved for 2part fractures. Deltoid splitting approach was used by exploring the axillary nerve on group a patients as described by codman, and deltopectoral approach was used on group b patients. Mar 21, 2019 the anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. Proximal humerus approach deltopectoral approach to. The subject underwent osteosynthesis for a fourpart proximal humerus fracture with medial comminution. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to. A quantitative comparison of the deltopectoral approach and the anterolateral acromial. The anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach.
The axillary nerve may be encountered in the inferior margin of this interval where it runs along the subcapularis prior to diving into the quadrangular space. The purpose of the present study nct00612391 was to compare outcomes for the deltoid split ds approach and the classic deltopectoral dp approach in terms of function, quality of life, and complications in a prospective randomized multicenter study using consort guidelines. For the remaining cases requiring surgery, there are numerous surgical techniques described in the literature to address them. Deltoidsplit approach versus deltopectoral approach for. Position plate the positioning of the philos long requires a partially lateral section of the deltoid muscle. Inspect inspect the long head of biceps brachii by palpation, at a point where it crosses the shoulder and. Debate exists over the optimal approach for addressing fractures of the proximal humerus. Anterior approach to the humerus orthopaedicsone articles. Compared to the conventional deltopectoral approach in the orif of a phf, the minimally invasive lateral approach has significant advantages in terms of lesser intraoperational surgery duration and blood loss, shorter hospitalization, lower postoperative complication rate, and quicker shoulder functional recovery. In fractures of the proximal humerus which consist of an anterior fragment one should take care to analyze the fracture pattern. One of the structures at risk during this approach is the axillary nerve.
The majority of proximal humeral fractures are undisplaced or minimally displaced and do not need surgery. Surgical technique for open reductioninternal fixation of. However, accessing the lateral aspect of the proximal humerus using this approach requires extensive soft tissue dissection and retraction, as it is an indirect approach to the plating zone. Group a consisted of a total of fiftysix patients of whom twentytwo were male and thirtyfour were female patients, with a mean age of 62. In vivo, manual rotation of the humerus following each exposure would.
This approach has recently been popularized for the copeland resurfacing and delta reversegeometry prostheses. Deltoidsplit or deltopectoral approaches for the treatment. Typically, the axillary nerve arises off the posterior cord of the brachial plexus and courses lateral to the proximal humerus and inferior to the glenohumeral joint, exiting the axilla through the. Shoulder lateral deltoid splitting approach approaches. Minimally invasive plate osteosynthesis with a locking. Start a longitudinal incision over the tip of the coracoid process of the scapula, extend it distally and laterally in the line of the deltopectoral groove to the insertion of the deltoid muscle on the lateral aspect of the humerus, about halfway down its shaft. Uses this approach is preferred for shoulder arthroplasty and for plateand screw fixation of proximal humeral fractures because it affords.
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